Common peroneal nerve entrapment

Findings

There is a history of pain, numbness, and “pins and needles” down the outside of the shin. The “pins and needles” distinguishes this form other local causes. Sensation may be reduced over the anterior compartment and there is local pain on palpation of the posterior lateral surface of the neck of the fibula. The knee joint is normal and the patient may have “bow legs”.

Cause

An uncommon irritation of the common peroneal nerve as it swings around the upper fibular neck.

Treatment

a)      Check if camber running could be causative. Rest from running and, possibly, even switch to “change of direction” sports, as these do not constantly repeat the sam stresses around the fibula.

b)      Avoid sitting with knees crossed and compressing the nerve, especially with the foot pulled behind the ankle.

c)      A lateral forefoot wedge may just reduce supination at forefoot lift off, and so ease the problem.

d)     Surgical release of the common peroneal nerve.

Sports

Mainly running and jumping, especially triple jump, when knee may bow outwards on foot impact. The problem is uncommon in change of direction sports. Plyomethrics  training, if done too often(less than 48 hours before trainings recovery time), may also cause this problem.

The diagnosis may be a lot harder to make, and a history lot more confusing, as some athletes present with lateral shin and foot pain. There are no pins and needles as such but, rather, ahyperaesthesia. Aggressive palpation of the common peroneal nerve around the fibula neck does not flare these symptoms, and EMG eventually provides the answer as a neuropraxia of this nerve. Although cortisone helps the tarsal and carpal tunnel, results in this area may not always occur. Rest and avoidance of the cause are the best treatments, with perhaps some adverse neural tensioning. 

"Concise guide to sports injuries, 2^nd edition",Churchill Livingstone, Malcolm T.F. Read,  foreword by Bryan English